Provider Demographics
NPI:1396516720
Name:WAVE CARE SERVICES LLC
Entity type:Organization
Organization Name:WAVE CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRANCHISE OWNER / MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-707-2880
Mailing Address - Street 1:1351 SHADY TREE LN
Mailing Address - Street 2:
Mailing Address - City:MEADOW VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95722-9358
Mailing Address - Country:US
Mailing Address - Phone:408-707-2880
Mailing Address - Fax:
Practice Address - Street 1:5875 PACIFIC ST STE B1
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3146
Practice Address - Country:US
Practice Address - Phone:408-707-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care